Cocaine use by pregnant women has reached epidemic proportions. Because of the effect of cocaine on the central nervous system, cocaine-exposed children are widely assumed to have long-term neurodevelopmental, language, and behavioral abnormalities, even though there are few data to support such claims. Our project will prospectively evaluate control and cocaine-exposed children for evidence of long term effects of central nervous system insult. Two cohorts of children, 123 control and 112 cocaine-exposed, enrolled in a prospective, longitudinal, blinded study since birth (NIDA#3-RO1-DA04965) will be followed from age 3-8 years. They will be evaluated every 6 months by psychologists blind to infant group status. Mental process variables (Test of Auditory Selective Attention, Goodman Lock Box), general development (Battelle Developmental Inventory), language development (Preschool Language Scale, Assessing Semantic Skills through Everyday Themes, Test of Problem Solving, and Test of Pragmatic Language) and intelligence (Wechsler Preschool and Primary Scale of Intelligence) will be measured. Neurologic status will be evaluated by a pediatric neurologist when subjects are 5 years of age. School adjustment and achievement will be evaluated by utilization of the Conners' Teachers Rating Scale and the Kaufman Test of Educational Achievement. Further, post-natal environmental influence on the child will be assessed by utilization of the Parent/Caregiver Involvement Scale, and the Home Observation for Measurement of the Environment. Continued addiction in the mother will be assessed through administration of the Addiction Severity Index. Multivariate statistical analyses will be used in order to determine whether cocaine use during pregnancy poses an independent risk factor for adverse outcome. Identification of the presence or absence of long term effects of cocaine on children is crucial. If adverse effects do occur, educators and policy makers must be prepared. If neurodevelopmental outcome is normal, labeling of these children as disabled must cease.